9. Spectrum of VHD – Right Sided VHD
Tricuspid Valve
Endocarditis
– IV drug abusers or in patients with IVs
Carcinoid HD - classically TS
TR – common, benign, may be secondary to
Pulm HTN
Pulmonic Valve
Pediatrics – Pulm Stenosis
Rheumatic HD – PI (Graham Steel Murmur)
Right sided valvular lesions change in intensity with
inspiration
12. Cardiac Physiology 101
Regurg/ Insuff – leaking (backflow) of blood across a closed valve
Stenosis – Obstruction of (forward) flow across an opened valve
Systole AV/PV – opens-------Aortic Stenosis
S1-S2 MV/TV – closes------Mitral Regurg
Diastole AV/PV – closes------Aortic Regurg
S2-S1 MV/TV – opens-------Mitral Stenosis
These concepts are set in stone, it can’t occur any other way,
It would be anatomically impossible
22. Aortic Stenosis
Diagnosis
– Ecg – LAE, LVH
– Echo 2D/color doppler –test of choice
– Cardiac Cath – helpful, confirmatory, needed if
the pt is older – look at the coronaries
23. Aortic Stenosis
Treatment of Symptomatic Aortic Stenosis or
Decreased LV Function
Medical Therapy – treats the symptoms not the cause
Aortic Valve Replacement
Bioprosthetic vs Mechanical AVR
30. Aortic Regurg – Austin Flint Murmur
Due to the vibration of the anterior leaflet of the mitral valve
as it is buffetted simultaneously by the blood jets from the left
atrium and the aorta.
31. Aortic Regurgitation
Diagnosis
– Ecg – LAE, LVH
– Echo 2D/color doppler –test of choice
– Cardiac Cath – helpful, confirmatory, needed if
the pt is older – look at the coronaries
32. Aortic Regurgitation
Treatment of Asymptomatic Aortic Regurg
Medical Therapy – treats the symptoms not the cause
• Serial Check ups with Echos (eval EF, Severity AR)
• SBE Prophylaxis
• Vasodialators (Nifedipine, ACE-I)
• Diuretics
Treatment of Symptomatic Aortic Regurg
Aortic Valve Replacement
Bioprosthetic vs Mechanical AVR
33. If you're not confused,
you're not paying
attention.
Tom Peters
50. Mitral Stenosis
Physical Exam
– Loud S1
– Opening Snap
– Diastolic Apical Rumble (murmur)
– May be associated with:
• MR or AS
• Right Sided Murmurs
o PI – Graham Steel Murmur
o TR
51. Mitral Stenosis
Diagnosis
– Ecg – A Fib, LAE, RAE, RVH
– Echo 2D/color doppler –test of choice
– Cardiac Cath – helpful, confirmatory, needed if
the pt is older – look at the coronaries
52. Mitral Stenosis
Treatment of Symptomatic Mitral Stenosis
Medical Therapy – treats the symptoms not the cause
• Diuretics – for congestion
• Digoxin, Beta and Ca Channel Blockers for Afib
rate control
• Anticoagulation – for AFib and LA clots
• SBE Prophylaxix – prevent endocarditis
53. Mitral Stenosis
Treatment of Symptomatic Mitral Stenosis
Surgical Therapy – treats the cause
• Percutaneous Ballon Valvulaoplasty – Non-
calcified, pliable valve
